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Zhao X, Yu A, Zhao H, Qiu Y. Diagnostic value of MRI in traumatic triangular fibrocartilage complex injuries: a retrospective study. BMC Musculoskelet Disord 2024; 25:63. [PMID: 38218805 PMCID: PMC10787402 DOI: 10.1186/s12891-023-07140-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) injuries commonly manifest as ulnar-sided wrist pain and can be associated with distal radioulnar joint (DRUJ) instability and subsequent wrist functional decline. This study aimed to assess the diagnostic value of MRI compared to wrist arthroscopy in identifying traumatic TFCC injuries and to determine the distribution of different TFCC injury subtypes in a normal clinical setting. METHODS The data of 193 patients who underwent both preoperative wrist MRI and wrist arthroscopy were retrospectively reviewed. The analysis focused on the proportion of subtypes and the diagnostic value of MRI in traumatic TFCC injuries, utilizing Palmer's and Atzei's classification with wrist arthroscopy considered as the gold standard. RESULTS The most prevalent subtype of TFCC injuries were peripheral injuries (Palmer 1B, 67.9%), followed by combined injuries (Palmer 1 A + 1B, 14%; Palmer 1B + 1D, 8.3%). Compared with wrist arthroscopy, the diagnostic sensitivity, specificity, negative predictive value (NPV), and Kappa value of MRI was as follows: traumatic TFCC tears 0.99 (95% CI: 0.97-1), 0.90 (0.78-0.96), 0.97 (0.87-1), and 0.93; styloid lamina tears 0.93 (0.88-0.96), 0.53 (0.30-0.75), 0.47 (0.26-0.69), and 0.44; and foveal lamina tears 0.85 (0.74-0.92), 0.38 (0.29-0.49), 0.79 (0.65-0.89), and 0.21. CONCLUSIONS The diagnostic value of MRI in traumatic TFCC injuries has been confirmed to be almost perfect using Palmer's classification. In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. Radiological associated injuries may offer additional diagnostic value in cases with diagnostic uncertainty.
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Affiliation(s)
- Xuanyu Zhao
- Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Fudan University, Shanghai, 200040, China
- Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, 200040, China
| | - Aiping Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University School of Medicine Affiliated 9th People's Hospital, Shanghai, 200011, China
| | - Huali Zhao
- Department of Radiology, Jing'an District Central Hospital, Fudan University, Shanghai, 200040, China
| | - Yanqun Qiu
- Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Fudan University, Shanghai, 200040, China.
- National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, 200040, China.
- Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, 200040, China.
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Minhas S, Kakar S, Wall LB, Goldfarb CA. Foveal Triangular Fibrocartilage Complex Tears: Recognition of a Combined Tear Pattern. J Hand Surg Am 2023; 48:1063.e1-1063.e6. [PMID: 35550309 DOI: 10.1016/j.jhsa.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/28/2022] [Accepted: 03/09/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Triangular fibrocartilage complex (TFCC) injuries are categorized most commonly by the Palmer and the Atzei and Luchetti classifications. Combined tears are reported less frequently, and the classification of these tears is unclear. In this study, we present a series of patients with combined central disc and foveal TFCC tears that do not fit into either of these classifications. METHODS Seventeen patients from 2 institutions presented with a combined central and foveal TFCC tear, confirmed by wrist arthroscopy between September 2017 and December 2020. Patient demographics, injury mechanism, associated injuries, clinical findings, magnetic resonance imaging results, surgeon description of tears, and treatment rendered were evaluated. RESULTS Patients were predominantly female (76%). Mean age was 40 years with a bimodal age distribution (7/17 patients <35 and 10/17 >45 years). Eleven patients (65%) sustained the injury from a fall. All had some degree of distal radioulnar joint (DRUJ) instability on clinical examination and almost half (8/17) had a history of a distal radius or ulnar styloid fracture during the initial injury. The foveal tear was confirmed by direct visual assessment and a positive hook test result; a suction test result commonly was positive as well. All patients underwent debridement of the central tear, and 16 of 17 underwent foveal TFCC repair with 1 having an irreparable tear. CONCLUSIONS We present a series of patients with combined central disc and foveal TFCC tears, a pattern that does not fit current classification schemes. All patients exhibited some degree of instability of the DRUJ and almost half had a history of distal radius or ulnar styloid fracture. Identification of a central tear of the TFCC, together with even subtle DRUJ instability, should lead to consideration of a coexistent foveal tear. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
- Shobhit Minhas
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | - Lindley Bevelle Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Charles Alan Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.
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Cerezal L, Del Piñal F, Atzei A, Schmitt R, Becce F, Klich M, Bień M, de Jonge MC, Teh J, Boutin RD, Toms AP, Omoumi P, Fritz J, Bazzocchi A, Shahabpour M, Zanetti M, Llopis E, Blum A, Lalam RK, Reto S, Afonso PD, Mascarenhas VV, Cotten A, Drapé JL, Bierry G, Pracoń G, Dalili D, Mespreuve M, Garcia-Elias M, Bain GI, Mathoulin CL, Van Overstraeten L, Szabo RM, Camus EJ, Luchetti R, Chojnowski AJ, Gruenert JG, Czarnecki P, Corella F, Nagy L, Yamamoto M, Golubev IO, van Schoonhoven J, Goehtz F, Sudoł-Szopińska I, Dietrich TJ. Interdisciplinary consensus statements on imaging of DRUJ instability and TFCC injuries. Eur Radiol 2023; 33:6322-6338. [PMID: 37191922 DOI: 10.1007/s00330-023-09698-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) injuries by an expert group using the Delphi technique. METHODS Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability and TFCC injuries. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panelists consisted of twenty-seven musculoskeletal radiologists. The panelists scored their degree of agreement to each statement on an 11-item numeric scale. Scores of "0," "5," and "10" reflected complete disagreement, indeterminate agreement, and complete agreement, respectively. Group consensus was defined as a score of "8" or higher for 80% or more of the panelists. RESULTS Three of fourteen statements achieved group consensus in the first Delphi round and ten statements achieved group consensus in the second Delphi round. The third and final Delphi round was limited to the one question that did not achieve group consensus in the previous rounds. CONCLUSIONS Delphi-based agreements suggest that CT with static axial slices in neutral rotation, pronation, and supination is the most useful and accurate imaging technique for the work-up of DRUJ instability. MRI is the most valuable technique in the diagnosis of TFCC lesions. The main indication for MR arthrography and CT arthrography are Palmer 1B foveal lesions of the TFCC. CLINICAL RELEVANCE STATEMENT MRI is the method of choice for assessing TFCC lesions, with higher accuracy for central than peripheral abnormalities. The main indication for MR arthrography is the evaluation of TFCC foveal insertion lesions and peripheral non-Palmer injuries. KEY POINTS • Conventional radiography should be the initial imaging technique in the assessment of DRUJ instability. CT with static axial slices in neutral rotation, pronation, and supination is the most accurate method for evaluating DRUJ instability. • MRI is the most useful technique in diagnosing soft-tissue injuries causing DRUJ instability, especially TFCC lesions. • The main indications for MR arthrography and CT arthrography are foveal lesions of the TFCC.
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Affiliation(s)
- Luis Cerezal
- Radiology Department, Diagnóstico Médico Cantabria (DMC), Castilla 6-Bajo, 39002, Santander, Spain.
| | - Francisco Del Piñal
- Instituto de Cirugía Plástica Y de La Mano, Serrano 58 1B, 28001, Madrid, Spain
| | - Andrea Atzei
- Pro-Mano, Treviso, Italy
- Ospedale Koelliker, Corso G. Ferraris 247, 10134, Torino, Italy
| | - Rainer Schmitt
- Department of Radiology, University Hospital LMU Munich, Ziemssenstraße 5, 80336, München, Germany
- Department of Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Maciej Klich
- Department of Traumatology and Orthopaedics, Postgraduate Medical Center, A. Gruca Teaching Hospital, Otwock, Poland
| | - Maciej Bień
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital Utrecht, Utrecht, The Netherlands
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Robert Downey Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA
| | - Andoni Paul Toms
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marco Zanetti
- Kantonsspital Baden, Im Ergel 1, CH-5404, Baden, Switzerland
| | - Eva Llopis
- Hospital de La Ribera. IMSKE. Valencia, Paseo Ciudadela 13, 46003, Valencia, Spain
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, UDL, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Radhesh Krishna Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Sutter Reto
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Radiology, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - P Diana Afonso
- Imaging Center, Radiology Department, Musculoskeletal Imaging Unit, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
- Hospital Particular da Madeira, HPA, Madeira, Portugal
| | - Vasco V Mascarenhas
- Imaging Center, Radiology Department, Musculoskeletal Imaging Unit, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
- AIRC, Advanced Imaging Research Consortium, Lisbon, Portugal
| | - Anne Cotten
- Musculoskeletal Radiology Department, Lille University Hospital Center, 59037, Lille, France
- Lille University School of Medicine, Lille, France
| | - Jean-Luc Drapé
- Service de Radiologie B, AP-HP Centre, Groupe Hospitalier Cochin, Université de Paris, 75014, Paris, France
| | - Guillaume Bierry
- MSK Imaging, University Hospital, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Grzegorz Pracoń
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, KT18 7EG, London, UK
| | - Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Creu Blanca, Pº Reina Elisenda 57, 08022, Barcelona, Spain
| | - Gregory Ian Bain
- Department of Orthopaedic Surgery, Flinders Medical Centre and Flinders University, Adelaide, South, Australia
| | | | - Luc Van Overstraeten
- Hand and Foot Surgery Unit (HFSU) SPRL, Rue Pierre Caille 9, 7500, Tournai, Belgium
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Route de Lennik 808, Brussels, Belgium
| | - Robert M Szabo
- Department of Orthopaedic Surgery, Health System, University of California Davis, 4800 Y Street, Sacramento, CA, 95817, USA
| | - Emmanuel J Camus
- IMPPACT Hand Surgery Unit, Clinique de Lille Sud, 94 Bis Rue Gustave Delory, Lesquin, France
- Laboratoire d'anatomie Fonctionnelle, ULB, Bruxelles, Belgium
| | | | - Adrian Julian Chojnowski
- Orthopaedics and Trauma Department, Hand and Upper Limb Surgery, Norfolk and Norwich University NHS Trust Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Joerg G Gruenert
- Department of Hand and Plastic Surgery Berit Klinik, Klosterstrasse 19, 9403, Goldach, Switzerland
| | - Piotr Czarnecki
- Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Ul. 28 Czerwca 1956R. Nr 135/147, 61-545, Poznań, Poland
| | - Fernando Corella
- Orthopedic and Trauma Department. Hospital, Universitario Infanta Leonor, C/ Gran Vía del Este N° 80, 28031, Madrid, Spain
- Hand Surgery Unit. Hospital Universitario Quirónsalud Madrid, Madrid, Spain
- Surgery Department, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Ladislav Nagy
- Division for Hand Surgery and Surgery of Peripheral Nerves, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, Switzerland
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Japan
| | - Igor O Golubev
- Hand and Microsurgery Division, Priorov Central Institute of Traumatology and Orthopedy, Moscow, Russia
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
| | - Tobias Johannes Dietrich
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Crowe CS, Kakar S. Structurally intact and functionally incompetent foveal triangular fibrocartilage complex injuries : an under-recognized spectrum of injury. Bone Joint J 2023; 105-B:5-10. [PMID: 36587253 DOI: 10.1302/0301-620x.105b1.bjj-2022-0908.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed.Cite this article: Bone Joint J 2023;105-B(1):5-10.
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Affiliation(s)
| | - Sanj Kakar
- Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Flores DV, Umpire DF, Rakhra KS, Jibri Z, Belmar GAS. Distal Radioulnar Joint: Normal Anatomy, Imaging of Common Disorders, and Injury Classification. Radiographics 2023; 43:e220109. [DOI: 10.1148/rg.220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dyan V. Flores
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Kawan S. Rakhra
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Zaid Jibri
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Gonzalo A. Serrano Belmar
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
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Fukuoka M, Nakamura T, Nishiwaki M, Toyama Y, Matsumoto M, Nakamura M, Sato K. Effects of peripheral tears of the triangular fibrocartilage complex on distal radioulnar joint stability: A biomechanical study. J Orthop Sci 2021; 26:1008-1013. [PMID: 33303299 DOI: 10.1016/j.jos.2020.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral triangular fibrocartilage complex (TFCC) tears may induce instability of the distal radioulnar joint (DRUJ). In this biomechanical study, simulated peripheral tears of the TFCC were examined on the stability of the DRUJ. Restabilization effect of the DRUJ by ulnar shortening and direct repair of those injuries were sequentially examined. METHOD The DRUJ stiffness was measured in intact, simulated two types of peripheral tears (ulnar and extended ulnodorsal) at three forearm positions: neutral, 60° pronation and 60° supination in 8 fresh frozen cadaver specimens. After the tears were sutured with stitches or after simulated ulnar shortening of 3 mm, the DRUJ stiffness was again measured. RESULTS The ulnar and ulnodorsal TFCC tears decreased the DRUJ stiffness significantly compared with the intact in all forearm positions. When ulnar shortening was done for the ulnar tear, the DRUJ stiffness increased significantly in the neutral and 60° pronated positions. When the ulnar TFCC tear was repaired, the DRUJ stiffness increased significantly in all forearm positions. DRUJ stiffness did not increase either with ulnar shortening or repair in ulnodorsal tear of the TFCC, however. CONCLUSION The simulated TFCC tears indicated significant loss of DRUJ stiffness. Direct repair or ulnar shortening was effective only on treatment of the ulnar tear of the TFCC in this study.
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Affiliation(s)
- Masatoshi Fukuoka
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan.
| | - Masao Nishiwaki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Takagi T, Nakamura T, Fukuoka M. Arthroscopic Capsular Repair for Triangular Fibrocartilage Complex Tears. J Wrist Surg 2021; 10:249-254. [PMID: 34109070 PMCID: PMC8169160 DOI: 10.1055/s-0040-1721140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/08/2020] [Indexed: 10/22/2022]
Abstract
Background The triangular fibrocartilage complex (TFCC) lesions are frequently implicated as a cause of ulnar wrist pain following impact and loading injuries. The objective of this study was to describe the clinical outcomes following TFCC lesion repair with the arthroscopic outside-in technique. Description of Technique We inserted a 21-gauge needle with 4-0 nylon loop perpendicular to the injured triangular fibrocartilage (TFC). We held two 4-0 nylon loops with mosquito forceps, drew them once out of the joint through a 4 to 5 portal, and put both sides through each loop. After that, we pulled out the 21-gauge needles and performed outside-in sutures after making a small incision and tying directly over the capsule. Patients and Methods Twenty-one wrists who underwent arthroscopic capsular repair were included. Arthroscopic findings were evaluated, and we used a distal radioulnar joint (DRUJ) evaluation system to monitor relief of pain, forearm rotation range of motion, and DRUJ stability postoperatively. Results Simple ulnar avulsion (Palmer 1B, Atzei Class 1) was recognized in ten wrists. A combination of the 1B tear with a horizontal TFC tear was noted in five wrists; and ulnar avulsion extending to the dorsal half of the TFC was identified in six wrists, including complete dorsal avulsion of the TFC from the capsule. There are significantly better results in the cases whose preoperative periods were 15 months or less. Conclusion The outside-in TFC repair technique produced excellent clinical results for peripheral detachment of the TFC in cases without severe DRUJ instability and with a preoperative period less than 15 months.
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Affiliation(s)
- Takehiko Takagi
- Department of Surgical Specialties, Division of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Masatoshi Fukuoka
- Department of Orthopaedic Surgery, Saitama City Hospital, Saitama, Japan
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Abe Y. Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage. Arthroscopy 2021; 37:1651-1653. [PMID: 33485941 DOI: 10.1016/j.arthro.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
The ulnar head attachment of triangular fibrocartilage complex is divided into 2 sections: the distal radioulnar ligament consists of superficial and deep bundles on both the palmar and dorsal sides, which attach at the fovea and the base of the ulnar styloid. A tear on the ulnar side of triangular fibrocartilage complex inevitably occurs at these attachments. Both magnetic resonance imaging and distal radioulnar joint (DRUJ) arthroscopy are crucial. DRUJ arthroscopy can clarify the tear location. An ulnar styloid tear can be treated by capsular repair. However, a foveal tear should be reattached to the fovea because this tear could cause gross DRUJ instability. There are several ways to reattach the bundles to the fovea, including single- or double-tunnel or bone anchors, and open versus arthroscopic.
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Displaced Flap Tears of the Triangular Fibrocartilage Complex: Frequency, Flap Location, and the "Comma" Sign on Wrist MRI. AJR Am J Roentgenol 2021; 217:707-708. [PMID: 33594905 DOI: 10.2214/ajr.20.25437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purposes of this study were to estimate the frequency of displaced triangular fibrocartilage complex (TFCC) tears and to describe their MRI characteristics. The total of 3411 wrist MRI examinations assessed showed 20 displaced TFCC tears in 17 patients (frequency, 0.5%). These flaps were characteristically connected to the TFCC via a pedicle ("comma" sign) in 19 of 20 cases and displaced into the distal radioulnar joint also in 19 of 20 cases. Management implications were considered.
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Arimitsu S, Masatomi T, Shigi A, Yukioka C, Moritomo H. Proximal Horizontal Flap Tears of TFCC Diagnosed by Computed Tomography Arthrography: Six Case Series. J Wrist Surg 2021; 10:36-41. [PMID: 33552693 PMCID: PMC7850808 DOI: 10.1055/s-0040-1716510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Background Proximal horizontal tears of the triangular fibrocartilage complex (TFCC) represent the tears at the proximal surface of the articular disk with a normal appearance of the distal surface. Preoperative diagnosis of TFCC flap tears is challenging. Objectives This report aims to present a diagnostic method using computed tomography (CT) arthrography for the proximal horizontal flap tears of the TFCC and to report our clinical outcomes. Patients and Methods Six patients were included who were preoperatively suspected to have proximal horizontal flap tears of the TFCC via CT arthrography. Arthrography was conducted by injecting dye into the distal radioulnar joint (DRUJ), and CT images were obtained immediately following arthrography. We performed arthroscopic or direct flap debridement with concomitant surgeries: ulnar shortening with positive ulnar variance and corrective osteotomy with the malunion following distal radius fracture. Results Preoperative CT arthrography clearly revealed the flaps to be flipped over toward the radiopalmar side of the DRUJ in four cases and a teardrop-shaped dye defect in two. We were able to identify the dislocated flap by arthroscopy avulsed from the proximal aspect of the articular disk within the DRUJ in all six cases. The mean pain level decreased from 10 preoperatively to 0.3 postoperatively on the visual analog scale. The mean patient-rated wrist evaluation score decreased from 43.5 preoperatively to 11.2 postoperatively. Conclusions Our study shows that CT arthrography can be a promising method for diagnosing proximal horizontal flap tears of the TFCC. Debridement of the flaps and concomitant surgeries showed satisfactory clinical results. Level of Evidence This is a Level 4, diagnostic study.
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Affiliation(s)
| | | | - Atsuo Shigi
- Department of Orthopaedics, Yukioka Hospital, Osaka, Japan
| | | | - Hisao Moritomo
- Department of Physical Therapy, Osaka Yukioka College of Health Science, Osaka, Japan
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Banjar M, Nor FEM, Singh P, Horiuchi S, Quek ST, Yoshioka H. Comparison of visibility of ulnar sided triangular fibrocartilage complex (TFCC) ligaments between isotropic three-dimensional and two-dimensional high-resolution FSE MR images. Eur J Radiol 2020; 134:109418. [PMID: 33302025 DOI: 10.1016/j.ejrad.2020.109418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/29/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Assessment of the ulnar attachment of the triangular fibrocartilage complex (TFCC) in a neutral forearm position remains challenging. Our study aims to evaluate the visibility of ulnar sided TFCC on 3 T MRI and compare isotropic 3D FSE sequences utilizing multiplanar reformation (MPR) with standard high-resolution 2D FSE sequences. METHODS Ninety-nine MRI wrist studies in patients with wrist pain were retrospectively analyzed. Patients were scanned with a neutral forearm position and reviewed with isotropic 3D coronal FSE proton density-weighted images (PDWI) and 2D coronal FSE PDWI. MPR was used for 3D assessment. Visibility of the dorsal radioulnar ligament (DRUL), triangular ligament (TL), and volar radioulnar ligament (VRUL) was assessed by three raters utilizing a five-point grading scale. Grades were compared between 2D and 3D sequences. Intrarater and interrater reliability for the delineation of anatomic structures was measured by Spearman's rank correlation coefficient, Cohen's kappa, and percentage of exact agreement/agreement within a range of ±1 score point. RESULTS Visibility grades in 3D were statistically significantly higher than those in 2D in all ligaments by all raters (p < 0.01). In Spearman's rank correlation coefficient and Cohen's kappa analysis, interrater correlations and agreements are variable but tended to be higher on 3D than on 2D. Both 2D and 3D sequences showed high intrarater exact agreement in all ligaments (80-91 % on 2D and 88-95 % on 3D). All exact interrater agreements on 3D were acceptable for TL (83-93 %) and acceptable to close to acceptable for VRUL (72-96 %). CONCLUSION The utilization of isotopic 3D imaging combined with MPR function significantly improves visibility of ulnar attachment of the TFCC.
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Affiliation(s)
- Mai Banjar
- Department of Diagnostic Imaging, National University Hospital, Singapore; Medical Imaging Department, King Abdullah Medical Complex Jeddah, Saudi Arabia.
| | | | - Pavel Singh
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Saya Horiuchi
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California, Irvine, CA, USA
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Abe Y. Editorial Commentary: Triangular Fibrocartilage Complex "Fovea"-An Attractive and Complicated Structure-Is "The Anchor" Not Only for Distal Radioulnar Joint but Also for Wrist Surgeons. Arthroscopy 2020; 36:1853-1855. [PMID: 32624121 DOI: 10.1016/j.arthro.2020.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
A triangular fibrocartilage complex foveal lesion is one of the key structures for stabilizing the distal radioulnar joint. Its anatomy is unique and healing potential is still controversial. If surgical repair is necessary, ulnar abutment is contraindicated, evaluation of the ligament condition using distal radioulnar joint arthroscopy is crucial to achieve satisfactory results.
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Schmitt R. [Radiology of the distal radioulnar joint and the ulnocarpal complex]. DER ORTHOPADE 2019; 47:637-646. [PMID: 29915995 DOI: 10.1007/s00132-018-3594-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
X-ray images exposed in neutral position and radiocarpally centred are essential in imaging of the distal radioulnar joint (DRUJ). The anatomic orientation of the DRUJ is favourable for acquiring transaxial scans to display its anatomy, subtle derangements, osteoarthritis and intra-articular fractures free from superpositions. The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the DRUJ. Provided that a focused clinical indication is given, high-resolution images are acquired, and an intra-venous or intra-articular contrast-agent is applied, all TFCC structures and destabilizing lesions can be displayed with the use of CT and MRI.
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Affiliation(s)
- R Schmitt
- Klinik für Diagnostische und Interventionelle Radiologie, Herz- und Gefäß-Klinik GmbH Bad Neustadt an der Saale, Salzburger Leite 1, 97616, Bad Neustadt, Deutschland. .,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland.
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Outcomes of Operative Treatment of Triangular Fibrocartilage Tears in Pediatric and Adolescent Athletes. J Pediatr Orthop 2018; 38:e618-e622. [PMID: 30134350 DOI: 10.1097/bpo.0000000000001243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) tears have been treated with increasing frequency in pediatric and adolescent patients over the past decade. There is little information on these injuries in young athletes and a scarcity of data regarding their ability to return to preinjury levels of athletic participation. The purpose of this study was to review the outcomes of pediatric and adolescent athletes with operatively treated TFCC tears with or without a concurrent ulnar shortening osteotomy and to determine their ability to return to their preoperative level of activity. METHODS A retrospective chart review was performed for all patients who underwent operative treatment of TFCC tears between 2006 and 2012 within one Upper Extremity practice. Patients were included if they were high-level athletes, unable to participate in their sport secondary to wrist pain and desired to return to their sport. All operative patients had imaging studies and clinical findings consistent with TFCC injury as the primary source of their activity-limiting pain and had failed nonoperative management prior to surgery. Patients without at least 3 months of documented postoperative follow up were excluded. RESULTS In total, 22 patients were included in the chart review with 20 patients willing to participate in a telephone survey and PODCI. Eighty percent of patients returned to their sport following operative treatment of their injury at an average of 4.8 months. Seven of the 22 patients underwent a concurrent ulnar shortening osteotomy for ulnar positive variance. All 20 patients reported satisfaction with the outcomes of their surgery and treatment. CONCLUSIONS Operative treatment of TFCC injuries in adolescent and pediatric athletes after failure of conservative treatment allowed return to sport at the previous level of participation. Concurrent ulnar shortening osteotomy in the setting of ulnar positive variance did not prohibit return to high-level athletic participation. LEVEL OF EVIDENCE Level IV.
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Abe Y, Fujii K, Fujisawa T. Midterm Results after Open versus Arthroscopic Transosseous Repair for Foveal Tears of the Triangular Fibrocartilage Complex. J Wrist Surg 2018; 7:292-297. [PMID: 30174985 PMCID: PMC6117178 DOI: 10.1055/s-0038-1641720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Purpose Various surgical procedures for foveal tears of the triangular fibrocartilage complex (TFCC) have been reported, and the procedures can be grossly divided into open and arthroscopic repair. The surgical results of both procedures were compared. Materials and Methods Twenty-nine patients underwent repair of a TFCC foveal tear. The 13 men and 16 women were in the age range of 14 to 72 years (average age, 30 years). Five patients had a history of distal radius fractures that healed uneventfully with nonoperative treatment. The mean duration of symptoms before surgery was 7.1 months. The procedure for repair consisted of 8 open repairs and 21 arthroscopic repairs. In both procedures, the TFCC was repaired transosseously to the ulna. The mean follow-up period was 34.4 (range, 24-70) months. The patients' pain, range of motion (ROM), grasping power, ulnar head instability, Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and Mayo modified wrist score (MMWS) were evaluated. The operating time was also compared. Results There were no significant differences between the groups in pain, ROM, grasping power, ulnar head instability, and DASH. The MMWS was excellent in 8 patients in the open repair group, with 18 excellent and 3 good in the arthroscopic repair group. The mean operating time was significantly shorter for arthroscopic repair than for open repair. Conclusion Satisfactory outcomes were achieved for both open and arthroscopic repair techniques in the midterm. If a surgeon becomes familiar with the arthroscopic repair, the arthroscopic technique would be more feasible than the open repair in terms of technical facility and shortening of the operating time. Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Yukio Abe
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
| | - Kenzo Fujii
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
| | - Takeyoshi Fujisawa
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
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Löw S, Herold A, Unglaub F, Megerle K, Erne H. Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion. J Wrist Surg 2018; 7:133-140. [PMID: 29576919 PMCID: PMC5864492 DOI: 10.1055/s-0037-1607073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
Background Arthroscopic debridement of the triangular fibrocartilage (TFC) is well accepted in patients with ulnar impaction syndrome with central TFC lesions. Treatment remains controversial, however, when there is no such lesion from radiocarpal view. Purpose This study assessed the clinical outcome of arthroscopic central TFC resection and debridement and secondary ulnar shortening in patients with ulnar impaction with central TFC lesion compared with patients without TFC lesion. Patients and Methods Thirty-two consecutive patients with ulnar impaction syndrome were arthroscopically treated, 16 of whom had a central lesion of the TFC that was debrided. In the 16 patients with no lesion from the radiocarpal view, the TFC was centrally resected and debrided to decompress the ulnocarpal joint. Persisting symptoms necessitated ulnar shortening in four patients in each group. Two patients underwent repeat arthroscopic TFC debridement. All patients were examined at 3, 6, and 12 months, and at final follow-up (mean: 1.7 years) following arthroscopy, respectively ulnar shortening or hardware removal. Results In both groups, pain, Krimmer, and DASH scores significantly improved. Improvements of DASH scores were significantly higher in patients without lesion at 12 months and at final follow-up. For other parameters, no significant difference was found between the two groups. Conclusion In both situations, with and without central TFC lesion, resection and debridement sufficiently reduced the ulnar-sided wrist pain and improved function in three out of four patients, and therefore qualified as the first-line treatment of ulnar impaction syndrome as arthroscopy is performed, anyway. Those patients who complained of persisting or recurrent ulnar-sided wrist pain finally benefitted from ulnar shortening osteotomy as the secondary procedure. Level of Evidence Therapeutic III, case-control study.
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Affiliation(s)
- Steffen Löw
- Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Alexandra Herold
- Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau, Germany
| | - Kai Megerle
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Holger Erne
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Abstract
This article shows trends in triangular fibrocartilage complex (TFCC) repair since 1990 by geographic area and year. The repair methods presented in the literature were inside-out, outside-in, all-inside, and open repair. The outside-in technique was reported most often for ulnar-side tears, whereas the inside-out technique was reported most frequently for radial-side tears. Recently, a foveal reattachment technique for ulnar-side tears has garnered attention and has been reported with increasing frequency, especially in Asia, because the deepest portion of TFCC, attached to fovea, plays a key role in stabilizing the distal radioulnar joint. Understanding these trends can help clinicians best treat TFCC tears.
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Abstract
Wrist arthroscopy is an efficient adjunct for intra-articular distal radius fracture fixation. However, performing wrist arthroscopy during the plate fixation is troublesome with the vertical traction applied and released. To facilitate the procedure, the authors developed a surgical technique, plate presetting arthroscopic reduction technique (PART), using a palmar locking plate. Since July 2005, they have performed PART for 248 intra-articular distal radius fractures with good and excellent results. Arthroscopic-assisted reduction of intra-articular fragments is superior to fluoroscopic assisted. PART also allows detection of intra-articular migration of fracture fragments, screw protrusion, and associated soft tissue injuries.
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Affiliation(s)
- Yukio Abe
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1, Yasuoka-cho, Shimonoseki 759-6603, Japan.
| | - Kenzo Fujii
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1, Yasuoka-cho, Shimonoseki 759-6603, Japan
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Omokawa S, Abe Y, Imatani J, Moritomo H, Suzuki D, Onishi T. Treatment of Intra-articular Distal Radius Fractures. Hand Clin 2017; 33:529-543. [PMID: 28673629 DOI: 10.1016/j.hcl.2017.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review of current literature discusses the morphology of the volar aspect of the distal radius; the surgical procedure, arthroscopic findings, and clinical results of a plate presetting and arthroscopic reduction technique for acute intra-articular fractures; and a novel simulation guidance system for malunited intra-articular fractures. Classification of intra-articular distal radius fractures is also discussed, focusing on central depression fracture fragments, associated soft tissue injuries, and results for measuring scapholunate distances at different sites. Problems of the distal radioulnar joint are reviewed, in particular, functional outcomes of the authors' prospective cohort study on unstable intra-articular fractures involving the distal radioulnar joint.
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Affiliation(s)
- Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8521, Japan.
| | - Yukio Abe
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1 Yasuoka-cho, Shimonoseki, Yamaguchi 759-6603, Japan
| | - Junya Imatani
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, 2-25 Kokutaicho Kita-ku, Okayama, Okayama 700-8511, Japan
| | - Hisao Moritomo
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Daisuke Suzuki
- Hand Surgery Center, Nishi-Nara Central Hospital, 1-15 Tsurumainishi, Nara, Nara 631-0024, Japan
| | - Tadanobu Onishi
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8521, Japan
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Ng AWH, Griffith JF, Fung CSY, Lee RKL, Tong CSL, Wong CWY, Tse WL, Ho PC. MR imaging of the traumatic triangular fibrocartilaginous complex tear. Quant Imaging Med Surg 2017; 7:443-460. [PMID: 28932701 DOI: 10.21037/qims.2017.07.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Triangular fibrocartilage complex is a major stabilizer of the distal radioulnar joint (DRUJ). However, triangular fibrocartilage complex (TFCC) tear is difficult to be diagnosed on MRI for its intrinsic small and thin structure with complex anatomy. The purpose of this article is to review the anatomy of TFCC, state of art MRI imaging technique, normal appearance and features of tear on MRI according to the Palmar's classification. Atypical tear and limitations of MRI in diagnosis of TFCC tear are also discussed.
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Affiliation(s)
- Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cindy S Y Fung
- Department of Diagnostic Imaging, North District Hospital, Hong Kong, China
| | - Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cina S L Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Clara W Y Wong
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Lim Tse
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pak Cheong Ho
- Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Mathoulin CL. Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex. J Hand Surg Eur Vol 2017; 42:551-566. [PMID: 28488448 DOI: 10.1177/1753193417708980] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This review includes updated understanding of the roles of intrinsic and extrinsic carpal ligaments in scapholunate instability and details the author's experience of indications, arthroscopic repair methods, and outcomes of treating the instability. A classification on triangular fibrocartilage complex injuries is reviewed, followed by author's indications, methods, and outcomes of arthroscopic repair of triangular fibrocartilage complex injuries.
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Abe Y, Moriya A, Tominaga Y, Yoshida K. Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment. J Wrist Surg 2016; 5:42-46. [PMID: 26855835 PMCID: PMC4742255 DOI: 10.1055/s-0035-1570037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
Background Several different triangular fibrocartilage complex (TFCC) tear patterns have been classified through the use of wrist arthroscopy. A tear of the dorsal aspect of the TFCC has been previously reported, but it is not included in Palmer original classification. Our purpose was to describe this type of tear pattern along with the clinical presentation. Methods An isolated dorsal TFCC tear was encountered in seven wrists of six patients (three men and three women; average age was 31 years). All patients were evaluated by physical exam, X-ray, plain axial computed tomography with pronation, neutral and supination position, magnetic resonance imaging (MRI) with coronal, sagittal, and axial section and arthroscopy. Results The clinical findings varied and included the following: tenderness at the dorsoulnar aspect of the wrist was positive in all wrists, fovea sign was positive in five wrists, and tenderness at the dorsal aspect of the distal radioulnar joint was present in one wrist. Pain with forearm rotation was positive in all wrists. The ulnar head ballottement test induced pain in all wrists, whereas dorsal instability of the ulnar head was present in one wrist with this test. The ulnocarpal stress test was positive in five wrists. Axial and sagittal images on MRI revealed the dorsal tear in five wrists. All wrists were treated with an arthroscopic capsular repair. The final functional outcome at an average follow-up of 16.1 months was four excellent and one good wrist according to the modified Mayo wrist score. Conclusions The aim of this article is to describe our experiences with tears involving the dorsal aspect of the TFCC, which may be misdiagnosed if the surgeon is not cognizant of this injury. Type of study/level of evidence Diagnostic/level IV.
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Affiliation(s)
- Yukio Abe
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Atsushi Moriya
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Yasuhiro Tominaga
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Koji Yoshida
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
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Abe Y, Yoshida K, Tominaga Y. Incidence and diagnosis of 'the double lesion' of the triangular fibrocartilage complex. J Hand Surg Eur Vol 2013; 38:807-8. [PMID: 23442342 DOI: 10.1177/1753193413479479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Y. Abe
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - K. Yoshida
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Y. Tominaga
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
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